Curiosity Posted October 19, 2012 Share Posted October 19, 2012 I'll try my hand at a scenario. I'm a little nervous doing this but I am curious to see if others might notice what I had missed. I must mention it was a very cold evening, let's say -30 C (-22 F). Call came in aprox 1900, low priority for a emotionally distressed patient. Arrive on scene in a decent neighborhood and are greeted at the door by a gentleman in his 60ies. He whispers to us that his friend has been really down and he came to check up on him today and finds that he is worse than normal. He states that his friend has no energy, is always tired, and has no motivation to do anything. He will not leave the house, his friends have been helping him out because of this. He is worried about what he might do. Initial contact: a man in his 60ies is seated on the couch. He is wearing a white tank top and a pair of slacks. He does track you as you walk in. You notice four bottles of medication on the coffee table in front of him, the house is well kept and nothing else out of the ordinary stands out. There are two other men standing in the living room who identify themselves as his friends. Patient states his mother, whom he lived with, passed away several weeks ago and he was having a hard time dealing with her passing. He says over the last few days, he's been more tired than normal, complains of weakness, says he has difficulty walking. He says all of this with a flat affect. Link to comment Share on other sites More sharing options...
Kaisu Posted October 19, 2012 Share Posted October 19, 2012 (edited) What are the meds? What are the vitals? What is the gentleman's medical history? Cardiac rhythm? and blood glucose? - and don't be nervous. So far, so good :-) edited for BGL in case some people don't consider that a vital sign Edited October 19, 2012 by Kaisu 1 Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 19, 2012 Share Posted October 19, 2012 Make sure you are between the door and the patient. Don't let the patient get between the door and you. Plus what are the other men there for? Link to comment Share on other sites More sharing options...
Curiosity Posted October 19, 2012 Author Share Posted October 19, 2012 What are the meds? What are the vitals? What is the gentleman's medical history? Cardiac rhythm? and blood glucose? Patient is pale, skin dry, patient does not feel warm. Mucous membranes appear moist and pale. HR: 58, strong, regular, 3 lead shows sinus brad, no st changes, p and t waves upright. Every now and then there appears to be some artifact, as though the leads are loose. 12 lead is the same. BP: 112/64 RR: 12, lungs are clear, no distress noted, patient does not complain of any difficulty breathing. Blood glucose comes back within normal limits but it was difficult getting blood from the finger prick. Pupils are equal and reactive Last oral intake at lunch, no nausea/vomitting/diarrhea Hx: hypertension, high cholesterol, depression Rx: atenolol, atorvastatin, citalopram. There is a bottle of lithium prescribed to his mother amongst his meds. No known allergies Make sure you are between the door and the patient. Don't let the patient get between the door and you. Plus what are the other men there for? They identify themselves as his friends. They visit him every few days to check up on him and help him around the house. They are the ones who called because they are worried his condition is getting worse. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 19, 2012 Share Posted October 19, 2012 good to know on the friends part. You never know. Sometimes friends turn out to be the patients worst enemy. But continue on. I'm in a scene safety sort of mood today. Link to comment Share on other sites More sharing options...
Curiosity Posted October 19, 2012 Author Share Posted October 19, 2012 But continue on. I'm in a scene safety sort of mood today. Friends are calm. They are standing in the corner of the room out of your way. There's nothing out of the ordinary around. Nothing that can endanger you or your partner that you can see. Only thing that stands out are the bottles of meds on the table and how hot it is in the house. (middle of winter, you have your big coats on ) Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 19, 2012 Share Posted October 19, 2012 (edited) are the bottles empty? When were they filled? How many are in the bottle and how many are gone. Do the numbers in the bottles mesh with the dates and how many SHOULD be gone? IF not then you treat as an overdose. What does the patient tell you? Any statements referring to ending it all? Any statements from the friends that relay the same? What are the medications?(missed the previous info) LIthium - NASTY NASTY overdose. I'd focus in on that pill bottle first. HOw many are in the bottle? Edited October 19, 2012 by Captain ToHellWithItAll Link to comment Share on other sites More sharing options...
Curiosity Posted October 19, 2012 Author Share Posted October 19, 2012 LIthium - NASTY NASTY overdose. I'd focus in on that pill bottle first. HOw many are in the bottle? Alright. When asked, the patient says he has been taking his meds as prescribed. Examining his prescriptions, that appears to fit with his story. The lithium was prescribed three months earlier for his mother. There are several pills left in the bottle, (I don't remember what the total number was, but there are some missing). When asked about it, the patient states that they are his mothers, he has never taken them, and they're there because he hasn't been able to throw them away yet. When asked again, he sticks with the story that he has not touched the lithium. I'm going to add something, because it was so apparent on scene and can't be conveyed over text. The patients affect is still flat. He shows absolutely no emotion. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 19, 2012 Share Posted October 19, 2012 He needs evaluation and treatment in a mental health facility but unless he says something to make me take him or unless I can convince him to go, then he's going to be left at the scene. His physical exam may also push him to go. But what will probably need to happen,(armchairing this) is that his friends will be the ones having to have to take him. Unless he decides to just go with me. I'm curious as to what other than the physical exam showed, what did he tell you in your questioning. Link to comment Share on other sites More sharing options...
emtdennis Posted October 19, 2012 Share Posted October 19, 2012 What has the patient been telling you about the way he feels beyond the passing of Mom? So far We've just mainly heard from the friends. The weakness is kinda sorta bothering me. When was his last physical? Is he willing to go to hosp for consult? Link to comment Share on other sites More sharing options...
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